Physicians Seldom Respond Empathetically to Concerns of Patients With Lung Cancer

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Title: Physicians Seldom Respond Empathetically to Concerns of Patients With Lung Cancer
URL: http://www.pslgroup.com/dg/22D3DA.htm
Doctor's Guide
September 22, 2008

CHICAGO -- September 22, 2008 -- In a small study of 20 audiorecorded interactions, physicians seldom responded empathetically to concerns raised by patients with lung cancer, according to a report in the September 22 issue of Archives of Internal Medicine.

"Empathy is an important element of effective communication between patients and physicians and is associated with improved patient satisfaction and compliance with recommended treatment," the authors write. However, responding to patients' emotional needs can be challenging for physicians.

Diane S. Morse, MD, University of Rochester Medical Center, Rochester, New York, and colleagues conducted an analysis of 20 recorded and transcribed consultations between lung cancer patients (average age 65 years, all male) and 9 physicians (3 oncologists and 6 thoracic surgeons).

Each visit contained an average of 326 statements, and those made by patients were coded into 3 themes: statements about the impact of lung cancer, statements about diagnosis or treatment, and statements about health system issues affecting care.

Throughout the 20 visits, the researchers identified 384 statements by patients that provided opportunities for physicians to offer empathy. These included statements such as "this is kind of overwhelming" and "I'm fighting it." In 61% of the cases, opportunities for empathy were classified as relating to the impact of lung cancer.

"Patients' morbidity and mortality expectations and concerns were the most commonly coded empathic opportunity, which hinted at fears, worries, and existential concerns and comprised 32% of overall empathic opportunities," the authors write.

Physicians responded with empathy to 39 (10%) of all 384 opportunities. "Otherwise, physicians provided little emotional support, often shifting to biomedical questions and statements," the authors say.

"With a mean of less than 2 empathic physician responses per encounter, empathy was an infrequent occurrence." Half of the empathic responses that physicians offered occurred in the last one-third of the encounter, although patients' concerns were raised throughout the visit.

The authors believe that physicians may not have time for empathic responses; they may be too busy with other tasks to recognise opportunities for empathy; or they may consciously avoid responding empathetically, perhaps believing that biomedical information is reassuring.

"We suggest the use of interval empathy to respond to empathic opportunities offered by patients periodically throughout the encounter, particularly in encounters with patients with life-threatening conditions who may be most likely to raise multiple empathic opportunities," the authors write.

"Use of this communication skill may allow increased understanding and progressive rapport and trust with patients. Fortunately, studies indicate that expressing empathy can be taught and that these statements can be brief and powerful, not prolonging the encounter or necessarily changing a physician's style."

SOURCE: Archives of Internal Medicine

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